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Management and Outcomes for Patients With Hodgkin Lymphoma With Partial Metabolic Response After First-Line Systemic
Donna Liao1, Mahmood Aminilari2, Xiang Y Ye3
1Temerty Faculty of Medicine, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
Practical Radiation Oncology
|March 1, 2026
Summary
Hodgkin lymphoma patients with partial metabolic response after chemotherapy can achieve durable remission with radiotherapy alone. Dynamic changes in SUVmax on PET scans can identify high-risk patients needing intensified treatment.
Area of Science:
- Oncology
- Nuclear Medicine
- Radiotherapy
Background:
- Hodgkin lymphoma (HL) management requires careful risk stratification.
- Partial metabolic response (PMR) on end-of-chemotherapy FDG-PET (EOC-PET) presents a management challenge.
- Standardized uptake value (SUVmax) kinetics may refine prognostication.
Purpose of the Study:
- To evaluate real-world management strategies for HL patients with PMR on EOC-PET.
- To assess the impact of SUVmax dynamics on risk stratification.
- To determine progression-free survival (PFS) based on post-EOC-PET management.
Main Methods:
- Retrospective, multi-centre cohort study (2009-2021) of HL patients with PMR (Deauville score 4).
- Analysis of management strategies: involved-site radiotherapy (RT), salvage chemotherapy ± ASCT, or observation.
- Cox proportional-hazards models used to assess PFS, with exploration of SUVmax kinetics.
Main Results:
- Of 836 patients, 67 met PMR criteria. RT was the most common strategy (n=38).
- Two-year PFS was 84.2% for RT, 52.7% for salvage chemotherapy, and 74.1% for observation.
- Salvage chemotherapy and observation were associated with higher progression risk (HR 5.82 and 5.74, respectively) compared to RT.
- Rising interim-to-EOC SUVmax (HR 7.21) and higher absolute EOC SUVmax predicted inferior PFS in the RT cohort.
Conclusions:
- Consolidative RT alone is effective for most HL patients with PMR, avoiding intensive salvage therapies.
- Dynamic SUVmax changes, particularly a rising interim-to-EOC SUVmax, identify a high-risk subgroup.
- Personalized therapy for PMR patients may benefit from integrating novel agents and advanced PET metrics in prospective studies.
